University Hospital of South Manchester NHS Foundation Trust (UHSM) for a number of years have been developing their Ambulatory Care (AEC) offer and in January 2016, UHSM looked to expand this with a month long pilot for Surgical Ambulatory Patients.

The Surgical Ambulatory Care Receiving Unit (SACRU) was developed to reduce the number of non-elective General Surgical admissions, by having a dedicated Emergency General Surgeon(s) to assess, diagnose and operate on patients who were previously being admitted to an inpatient bed.

SACRU led by Consultant General Surgeon Miss Patrizia Capozzi and with support of the Trust’s Service Transformation Team and their Senior Programme Manager James Gray commenced the pilot with a number of clear of objectives including:

• Fast-tracking self-presenting patients through ED from triage

• Reduce the number of unnecessary emergency general surgery admissions

• Facilitate accelerated ward discharges

• Reduce the number of GP patient referrals coming into ED

• Point of contact for patients, DNs, GPs • Expand Emergency General Surgery services

• Provide a more enhanced patient focused service

• Ensure all patients are seen by a consultant within 14 hours of presentation

• Drive care quality improvement

During the pilot, SACRU was delivered by a single Consultant undertaking a morning ambulatory clinic Mon-Fri (8:30 – 12:30).

Over the 4 week pilot period, 19 days of activity were completed. During that time a total of 133 patients were seen of which 72% were new patients, 17% were reviews and 11% were telephone reviews.

The success of SACRU was measured during the pilot period through the number of admissions avoided (83/62%), ED re-attendances avoided (34/26%). Only a small percentage (8%) of those patients seen within SACRU, were admitted to a surgical inpatient bed or referred to another speciality (4%).

The pilot averaged 4.2 admissions avoided per day based on the opening hours of 8.30am to 12.30pm.

Based on this anticipated activity that would be seen through the unit, by extending to a 12 hour service and increasing the opening hours by an extra 8 hours per day seven days a week would provide a projected 154 admissions avoided per month. This avoidance equates to a potential saving of 10 inpatient beds which could be used for extra elective activity or to help manage the demand of non-elective medical patients.

In July 2016 UHSM’s Management Board agreed to fund a fully operational SACRU in line with National expectations for 7 day services.

The integration of SACRU is serving to enhance the offer available to patients and ensure that Emergency General Surgery is optimised to improve patient flow and quality of care further. Whilst the unit is currently not fully operational past 12.30pm Monday to Friday, the introduction of two new Trainee Advanced Nurse Practitioners, Rachael Hine and Gail Sharpe will help support the development of the unit and the provision of services to patients at UHSM and across South Manchester moving forward.

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